Female urinary incontinence Flashcards
What is urinary incontinence?
Any involuntary leakage of urine
What is stress incontinence?
Involuntary leakage on effort or exertion eg sneezing/coughing
What is urge incontinence?
Involuntary leakage accompanied by or immediately preceded by urgency
Does prevalence of urinary incontinence increase with age?
Yes
What are risk factors for urinary incontinence?
Age Parity Menopause Smoking Medical problems Increased intraabdominal pressure Pelvic floor trauma Denervation Connective tissue disease Surgery
What questions should be asked in the history of a patient presenting with urinary incontinence?
Age Parity Mode of deliveries Weight of heaviest baby Smoking Diabetes Anti hypertension medicines Heart/kidney/liver problems Previous pelvic floor muscle training/surgical treatment
What should be examined in a woman with bladder/pelvic floor problems?
Prolapse Stress incontinence Uro-genital atrophy changes Pelvic mass Pelvic floor tone, strength, awareness
What investigations can be done into urinary incontinence?
Urinalysis
Post voiding residual volume assessment
Urodynamics
What is uroflowmetry?
Measures flow rate of urine in ml/s
What determines flow rate of urine?
Urethral resistance, strength of detrusor contraction, and abdominal straining
How is urinary incontinence managed?
Lifestyle changes
Medical treatments
Physiotherapy
Surgery
What lifestyle changes can be made to improve urinary incontinence?
Stop smoking
Lose weight
Eat more healthily
Stop drinking alcohol and caffeine
Why might someone not receive conservative treatment of urinary incontinence?
Patient doesn’t wish it
Previously failed
No facilities
What are benefits to pelvic floor muscle training?
Reinforcement of cortical awareness of muscle groups
Hypertrophy of existing muscle fibres
General increase in muscle tone and strength
What drug can be used for treatment of stress urinary incontinence?
Yentreve (duloxetine)
Should duloxetine be used alone for treatment?
No - used alongside pelvic floor muscle training
Who would require duloxetine in primary care?
If pelvic floor muscle training has failed or would be enhanced by prescription of duloxetine
When would someone require duloxetine in secodary care?
Does not wish surgery
Not fit for surgery
After failed surgery
When patients family is not complete
What is overactive bladder syndrome?
A symptom complex usually, but not always, related to urodynamically demonstable detrusor overactivity
What are defining symptoms of overactive bladder syndrome?
Urgency (with/without urgency incontinence), usually with frequency and nocturia
What are risk factors for urge incontinence?
Advanced age
Diabetes
UTI
Smoking
How should overactive bladder be managed?
Treat symptoms
No immediate cure
Multidisciplinary approach
Requires dedicated team
What are lifestyle interventions for overactive bladder?
Normalise fluid intake
Reduce caffeine, fizzy drinks, chocolate
Stop smoking
Weight loss
